Worldwide incidence of malaria in 2009: estimates, time trends, and a critique of methods.
Worldwide incidence of malaria in 2009: estimates, time trends, and a critique of methods.
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DOI：
10.1371/journal.pmed.1001142
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发表时间：
2011-12
期刊：
影响因子：
15.8
通讯作者：
Dye C
中科院分区：
文献类型：
--
作者：
Cibulskis RE;Aregawi M;Williams R;Otten M;Dye C
Richard Cibulskis及其同事对2009年全球疟疾发病率进行了估计，并对不同的估计方法提出了批评，包括基于寄生虫流行调查构建的风险图的估计方法，以及基于卫生部编制的常规病例报告的估计方法。衡量实现千年发展目标6的进展情况，包括对疟疾病例数的估计及其时间趋势，依赖于根据寄生虫流行率调查绘制的风险图以及各国卫生部编制的例行病例报告。在此，我们对这两种方法进行了批判，并以2009年全国发病率估计为例进行了说明。我们收集了99个存在疟疾传播的国家疟疾控制规划报告的病例数信息。我们对71个国家的恶性疟原虫和间日疟原虫的总发病率进行了估算，方法是利用以下数据调整报告病例数：报告完整性、疑似寄生虫阳性的比例、每种疟原虫的确诊病例比例以及患者使用公共部门卫生设施的程度。这四个因素在不同的国家和地区差别很大。对于常规监测数据不太可靠的28个非洲国家，我们通过将疟疾传播措施与病例发病率联系起来的基于模型的方法估计了病例数。2009年，非洲98%的病例是由恶性疟原虫引起的，其他区域为65%。据估计，全世界有2.25亿例疟疾病例（第5 - 95百分位，1.46 - 3.16亿），非洲区域有1.76亿例（1.1 - 2.48亿），其他地区有49亿例（36-68）。我们的估计低于其他公布的数字，特别是对非洲以外国家的基于调查的估计。常规监测数据得出的疟疾发病率估计值通常低于寄生虫流行率调查得出的估计值。经过仔细解释的监测数据可用于监测疟疾趋势，以应对控制工作，并突出需要加强疟疾规划和卫生信息系统的领域。随着世界各地疟疾发病率的下降，对控制工作的评价将越来越依赖于强有力的常规监测系统。疟疾是一种由疟原虫引起的威胁生命的疾病，它通过受感染蚊子的叮咬传播给人。根据世界卫生组织（世卫组织）的最新估计，2009年全世界有2.25亿疟疾病例，估计有781 000人死亡，其中大多数死亡发生在生活在世卫组织非洲区域（主要是撒哈拉以南非洲）的儿童中。了解任何国家的疟疾负担是公共卫生规划的一个重要组成部分，准确估计全球负担对于监测联合国千年发展目标的进展情况至关重要。目前，用于估计疟疾发病率的方法一般有两种：一种方法使用国家卫生部编制的疟疾病例例行监测报告，对这些报告进行分析，以考虑到数据收集方面的一些缺陷，例如卫生设施报告不完整、发烧患者可能过度诊断疟疾、使用私人卫生设施或根本不使用私人卫生设施。第二种方法是对疟疾流行地区选定地点的疟原虫流行率和病例发病率进行基于人口的调查，然后利用这些信息生成风险图，并估计世界所有疟疾流行地区每1000人的疟疾病例发病率。疟疾地图集项目——一个基于医疗情报和卫星气候数据的疟疾流行病学数据库——使用了第二种方法。为了使疟疾流行病学尽可能准确，有必要评估这两种方法的优缺点。在这项研究中，这组科学家分析了使用不同方法计算的估计值的优点，强调了需要改进这两种方法的领域，以便更好地评估疟疾控制。这组科学家利用这两种方法的结合估计了2009年存在疟疾传播的99个国家中每个国家的疟疾病例数。这组科学家对世界卫生组织非洲地区以外的56个疟疾流行国家和9个非洲国家使用了第一种方法，这些国家拥有必要的数据质量，可以使用这组科学家设计的统计模型来计算估算值。这组科学家设计的统计模型考虑了病例发现的上限和下限。这组科学家对非洲地区的34个国家使用了第二种方法，将疟疾风险分为低传播和高传播两类，然后从在没有疟疾控制活动的人群中进行的观察性研究中得出人群的发病率。对于这两种方法，研究人员都进行了统计分析，以确定不确定性的范围。这组科学家发现，在99个疟疾流行国家中，使用多种方法总共发现了2.25亿例疟疾病例，其中大多数病例（78%）发生在世卫组织非洲区域，其次是东南亚（15%）和东地中海区域。在非洲，每1,000人中有214例病例，而东地中海区域为每1,000人中有23例，东南亚区域为每1,000人中有19例。16个国家占全球所有估计病例的80%——除两个国家外，所有国家都在非洲区域。研究人员发现，尽管方法1和方法2之间存在差异，但国家估计的上限和下限的比例大致相同。使用这些综合方法，估计疟疾发病率低于以前的估计，特别是在非洲以外。然而，这些方法表明，疟疾监测系统目前错过了大多数病例，在全球估计发生的病例中发现的不到10%。虽然对疟疾负担和趋势的最佳评估应依赖于监测和调查数据的结合，但准确的监测是疟疾控制规划的最终目标，特别是常规监测在估算空间和时间上的病例发病率方面具有优势。然而，正如研究人员在本研究中发现的那样，加强监测需要对固有错误进行批判性评估，必须充分解决这些错误，以便对疟疾负担和趋势的估计有信心，从而对疟疾控制项目的投资回报有信心。请通过本摘要的在线版本http://dx.doi.org/10.1371/journal.pmed.1001142访问这些网站。世卫组织每年提供疟疾信息并编制《世界疟疾报告》，总结疟疾控制方面的全球进展
Richard Cibulskis and colleagues present estimates of the worldwide incidence of malaria in 2009, together with a critique of different estimation methods, including those based on risk maps constructed from surveys of parasite prevalence, and those based on routine case reports compiled by health ministries. Measuring progress towards Millennium Development Goal 6, including estimates of, and time trends in, the number of malaria cases, has relied on risk maps constructed from surveys of parasite prevalence, and on routine case reports compiled by health ministries. Here we present a critique of both methods, illustrated with national incidence estimates for 2009. We compiled information on the number of cases reported by National Malaria Control Programs in 99 countries with ongoing malaria transmission. For 71 countries we estimated the total incidence of Plasmodium falciparum and P. vivax by adjusting the number of reported cases using data on reporting completeness, the proportion of suspects that are parasite-positive, the proportion of confirmed cases due to each Plasmodium species, and the extent to which patients use public sector health facilities. All four factors varied markedly among countries and regions. For 28 African countries with less reliable routine surveillance data, we estimated the number of cases from model-based methods that link measures of malaria transmission with case incidence. In 2009, 98% of cases were due to P. falciparum in Africa and 65% in other regions. There were an estimated 225 million malaria cases (5th–95th centiles, 146–316 million) worldwide, 176 (110–248) million in the African region, and 49 (36–68) million elsewhere. Our estimates are lower than other published figures, especially survey-based estimates for non-African countries. Estimates of malaria incidence derived from routine surveillance data were typically lower than those derived from surveys of parasite prevalence. Carefully interpreted surveillance data can be used to monitor malaria trends in response to control efforts, and to highlight areas where malaria programs and health information systems need to be strengthened. As malaria incidence declines around the world, evaluation of control efforts will increasingly rely on robust systems of routine surveillance. Please see later in the article for the Editors' Summary Malaria is a life-threatening disease caused by the Plasmodium parasite, which is transmitted to people through the bites of infected mosquitoes. According to latest estimates from the World Health Organization (WHO), in 2009, there were 225 million cases of malaria and an estimated 781,000 deaths worldwide—most deaths occurring among children living in the WHO African Region (mainly sub-Saharan Africa). Knowing the burden of malaria in any country is an essential component of public health planning and accurately estimating the global burden is essential to monitor progress towards the United Nations' Millennium Development Goals. Currently, there are generally two approaches used to estimate malaria incidence: One method uses routine surveillance reports of malaria cases compiled by national health ministries, which are analyzed to take into account some deficincies in data collection, such as incomplete reporting by health facilities, the potential for overdiagnosis of malaria among patients with fever, and the use of private health facilities or none at all. The second method uses population-based surveys of Plasmodium prevalence and case incidence from selected locations in malaria endemic areas and then uses this information to generate risk maps and to estimate the case incidence of malaria per 1,000 population, for all of the world's malaria endemic regions. The Malaria Atlas Project—a database of malaria epidemiology based on medical intelligence and satellite-derived climate data—uses this second method. In order for malaria epidemiology to be as accurate as possible, an evaluation of the strengths and weaknesses of both methods is necessary. In this study, the researchers analyzed the merits of the estimates calculated by using the different approaches, to highlight areas in which both methods need to be improved to provide better assessments of malaria control. The researchers estimated the number of malaria cases in 2009, for each of the 99 countries with ongoing malaria transmission using a combination of the two methods. The researchers used the first method for 56 malaria endemic countries outside the WHO African Region, and for nine African countries which had the quality of data necessary to calculate estimates using the researchers statistical model—which the researchers devised to take the upper and lower limits of case detection into account. The researchers used the second method for 34 countries in the African Region to classify malaria risk into low-transmission and high-transmission categories, and then to derive incidence rates for populations from observational studies conducted in populations in which there were no malaria control activities. For both methods, the researchers conducted a statistical analysis to determine the range of uncertainty. The researchers found that using a combination of methods there was a combined total of 225 million malaria cases, in the 99 countries malaria endemic countries—the majority of cases (78%) were in the WHO African region, followed by the Southeast Asian (15%) and Eastern Mediterranean regions. In Africa, there were 214 cases per 1,000 population, compared with 23 per 1,000 in the Eastern Mediterranean region, and 19 per 1,000 in the Southeast Asia region. Sixteen countries accounted for 80% of all estimated cases globally—all but two countries were in the African region. The researchers found that despite the differences between methods 1 and 2, the ratio of the upper and lower limit for country estimates was approximately the same. Using the combined methods, the incidence of malaria was estimated to be lower than previous estimates, particularly outside of Africa. Nevertheless the methods suggest that malaria surveillance systems currently miss the majority of cases, detecting less than 10% of those estimated to occur globally. Although the best assessment of malaria burden and trends should rely on a combination of surveillance and survey data, accurate surveillance is the ultimate goal for malaria control programs, especially as routine surveillance has advantages for estimating case incidence, spatially and through time. However, as the researchers have identified in this study, strengthening surveillance requires a critical evaluation of inherent errors and these errors must be adequately addressed in order to have confidence in estimates of malaria burden and trends, and therefore, the return on investments for malaria control programs. Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001142. This study is further discussed in a PLoS Medicine Perspective by Ivo Mueller and colleagues The WHO provides information on malaria and produces the World Malaria Report each year, summarizing global progress in malaria control More information is available on The Malaria Atlas Project
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影响因子：
15.8
作者：
Guerra, Carlos A.;Gikandi, Priscilla W.;Tatem, Andrew J.;Noor, Abdisalan M.;Smith, Dave L.;Hay, Simon I.;Snow, Robert W.
通讯作者：
Snow, Robert W.
影响因子：
3
作者：
Patil, Anand P.;Okiro, Emelda A.;Hay, Simon I.
通讯作者：
Hay, Simon I.
疟疾风险的全球分布和人口：过去，现在和未来。
影响因子：
56.3
作者：
Hay, SI;Guerra, CA;Tatem, AJ;Noor, AM;Snow, RW
通讯作者：
Snow, RW
DOI：
10.4269/ajtmh.2001.64.57
发表时间：
2001-01-01
影响因子：
3.3
作者：
Murphy, SC;Breman, JG
通讯作者：
Breman, JG
影响因子：
3
作者：
Meyrowitsch, Dan W.;Pedersen, Erling M.;Simonsen, Paul E.
通讯作者：
Simonsen, Paul E.